Local doctors are slugging it out with Regence BlueShield, Washington's largest health insurer, over changes in the new Regence contract. The doctors say that, in the interest of cost, the insurer wants to limit their ability to prescribe the best care possible for patients; that, in fact, Regence wants to do the prescribing--or give employers the power to do it instead. This is probably true, but then it's hard for patients to sympathize with doctors or care about this squabble, when doctors and the American Medical Association have been instrumental in limiting patients' access to various treatments for decades--especially access to alternative medicine.

The standard argument against alternative therapies is that they're "unproven" or "untested," as if a laboratory test on rats, rabbits, or pigs, followed by a test on 20-year-old, healthy, male college students is the ideal way to prove the efficacy of anything. People who have been driven to try alternative or "naturopathic" medicine by the outright failure of western or "allopathic" medicine to help them have discovered that massage, acupuncture, herbal remedies, vitamin therapies, and many other alternative treatments have long and distinguished histories--literally centuries, for some treatments. There's a lot of empirical evidence showing the benefits these therapies can provide to people suffering from chronic pain, fatigue, immune deficiencies, high blood pressure, heart disease, and a whole host of other illnesses that western medicine either finds difficult to treat or treats only with therapies that are difficult for the patient to tolerate and/or survive.

Many doctors use just that argument against alternative therapies: just because many people experience benefits from them isn't good enough. In other words, until we understand exactly why or how these treatments work, we shouldn't use them. Yet many treatments prescribed by doctors rely on empiricism (i.e., patient's experiences, rather than a scientific understanding of exactly how the treatment works in the patient's body). For example, until very recently, no one understood exactly how anesthesia and pain killers worked to dull pain; there were a lot of theories, but no proof of how these chemicals actually worked in the nervous system. Doctors and the medical community nevertheless relied heavily on both and have done so for over a century. So empirical evidence--the knowledge gained from experience, observation, and patient feedback--was enough to make anesthesia a common treatment, even in light of the known risks; people can and do die under general anesthesia from incorrect dosages or adverse reactions. It happens. But the need obviously outweighs the risks. On the other hand, who dies from receiving a massage?

The other main argument against alternative therapies, especially herbs and dietary supplements, is the danger of poisoning or of adverse reactions. There's no minimizing this danger; it's real and nothing to ignore. But we should put it in perspective. Joe and Teresa Graedon, authors of The People's Guide to Deadly Drug Interactions, estimate that there are over 20,000 adverse drug/drug, drug/food, and drug/vitamin interactions reported in the medical literature. It's simply impossible for anyone to keep track of them all, nor is anyone even bothering to try--not your doctor, not your pharmacist, not the FDA, not insurance companies, not pharmaceutical companies, and certainly not the government. In the best of all possible worlds, there would be a movement to collect such information in a format that's easy to read and accessible for both patients and physicians. Yet no coordinated movement exists to provide this basic necessity.

So we have plenty of people every year who unwittingly poison themselves by taking two prescription medicines that interact badly with one another--often ones prescribed by the same doctor. Or, in one of the most common drug/drug interactions, people may accidentally kill themselves by taking MAO inhibitors, such as Nardil or Parnate (anti-depressants), in combination with over-the-counter cold medicines that contain Sudafed or similar decongestants (pseudoephedrine, ephedrine, phenylephrine or phenylpropanolamine). This combination can cause blood pressure to soar and bring on a stroke; although, some lucky folks only suffer nausea, fever, dizziness, and seizures.

Then there are the drugs that cancel each other out. Aspirin may deactivate drugs that lower blood pressure, like Vasotec and Capoten, which are among the 20 most commonly prescribed drugs in the U.S. The most common medicines for migraine headache, Fiorinal and Fioricet, both contain a barbiturate that reduces the effectiveness of birth control pills; ironically, about 70% of migraine sufferers are women. Birth control pills can also be hampered by the commonly-prescribed antibiotics, such as ampicillin, amoxicillin, tetracycline, oxacillin, penicillin V, and doxycycline. Any of these drugs can be prescribed for pelvic inflammations or urinary-tract infections, which are common among sexually-active women. And finally, oral antifungal medicines that doctors prescribe for vaginal yeast infections can also inhibit oral contraceptives; the biggest culprit is griseofulvin.

Numerous over the counter medicines have nasty side-effects or can combine with prescription drugs in dangerous ways. One example is aspirin; it's in everybody's home medicine cabinet, and lots of folks take it like it's candy. They shouldn't. If taken with anticoagulants (blood thinners), aspirin can cause dangerous, excessive bleeding. It can also reduce the effectiveness of arthritis drugs, like ibuprofen, naproxen, or sulindac. Aspirin may interfere with beta-blockers, another class of drugs that treat high blood pressure. Taken with diabetes drugs, aspirin can trigger sudden, dangerous drops in blood glucose levels. It can also hamper the body's ability to metabolize certain drugs, thereby increasing those drugs to toxic levels in the body; included in this group are epilepsy drugs, glaucoma drugs, and methotrexate (used to treat rheumatoid arthritis and cancer). Gout medicine can be completely inactivated by just 700 mg of aspirin (2-3 pills). And, of course, aspirin is just plain hard on your stomach; it blocks prostaglandins that work to maintain the coating that protects the lining of your digestive tract. Yet no one has suggested that we give up our aspirin. Doctors even recommend that older people take one aspirin a day to thin the blood and prevent a heart attack.

So, faced with the dangers of commonly used drugs, alternative therapies seem mild in comparison, especially when weighed against the obvious needs of people who can't be helped by western medicine. The solution is not to exclude alternative therapies from the ever shrinking list of what insurance companies will fund or what doctors will prescribe. Until we have a healthcare system that eliminates the insurance companies and reduces or eliminates the profit motive, doctors will continue to ignore alternative treatments while fighting to preserve the few treatment options they have now. And the way to make both allopathic and naturopathic medicines safer is to start compiling a database of adverse drug reactions and interactions--and include herbs, vitamins, and other supplements, too. No private, for-profit entity will do it; the responsibility lies with us.